Prolonged post-recurrence survival following pleurectomy/decortication for malignant pleural mesothelioma

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Mesothelioma Research

Background:

• Malignant pleural mesothelioma (MPM) is a rare and aggressive cancer.
• Surgical options like extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D) are used for resectable MPM.
• Neoadjuvant chemotherapy followed by surgery is a common treatment strategy.

Purpose of the Study:

• To compare the surgical outcomes of EPP versus P/D in patients with MPM.
• To evaluate overall survival (OS), progression-free survival (PFS), and post-recurrence survival (PRS) between the two surgical approaches.
• To assess the impact of surgical procedure on postoperative pulmonary function.

Main Methods:

• Retrospective review of 44 patients with resectable MPM who underwent neoadjuvant chemotherapy followed by either EPP (n=29) or P/D (n=15).
• Comparison of patient demographics, oncological outcomes, and survival data between the EPP and P/D groups.
• Statistical analysis including univariate and multivariate analyses to identify prognostic factors.

Main Results:

• Overall survival was significantly better in the P/D group (median 34 months) compared to the EPP group (median 17 months).
• No significant difference in progression-free survival was observed between P/D and EPP.
• Post-recurrence survival was significantly longer in the P/D group, and postoperative pulmonary function improved more with P/D.

Conclusions:

• Pleurectomy/decortication (P/D) may be a viable alternative to extrapleural pneumonectomy (EPP) for resectable malignant pleural mesothelioma.
• P/D demonstrates comparable progression-free survival with improved post-recurrence survival and better postoperative pulmonary function.
• Epithelial histology and P/D were identified as favorable prognostic factors for overall survival in univariate analysis, but only epithelial histology remained significant in multivariate analysis.